1205175817 NPI number — ADVANCED INVASIVE PAIN MANAGEMENT OF HOUSTON

Table of content: (NPI 1205175817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205175817 NPI number — ADVANCED INVASIVE PAIN MANAGEMENT OF HOUSTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED INVASIVE PAIN MANAGEMENT OF HOUSTON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205175817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 W PARKWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
FRIENDSWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77546-5478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-943-7246
Provider Business Mailing Address Fax Number:
713-943-2040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 MORRIS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKMULGEE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74447-6429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-925-9905
Provider Business Practice Location Address Fax Number:
918-708-1362
Provider Enumeration Date:
02/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BALLARD
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
832-487-7709

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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